Bayraktar Yusuf, Harmanci Ozgur
Hacettepe University Faculty of Medicine, Department of Gastroenterology, 06100 Sihhiye, Ankara, Turkey.
World J Gastroenterol. 2006 Feb 28;12(8):1165-74. doi: 10.3748/wjg.v12.i8.1165.
The thrombophilia which can be either congenital or acquired in adult life has major implications in the abdominal vessels. The resulting portal vein thrombosis, Budd-Chiari syndrome and mesenteric vein thrombosis have a variety of consequences ranging from acute abdomen to chronic hepatomegaly and even totally asymptomatic patient in whom the only finding is pancytopenia. The complications like esophageal varices, portal gastropathy, ascites, severe hypersplenism, liver failure requiring liver transplantation are well known. Interesting features of collateral venous circulation showing itself as pseudocholangiocarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of intraabdominal vessel thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we presented and discussed the abdominal venous thrombosis, etiology and the resulting clinical pictures. There are controversial issues both in nomenclature, and management including anticoagulation problems and follow up strategies. In light of the current knowledge, we discussed some controversial issues in literature and presented our experience and our proposals about this group of patients.
血栓形成倾向在成人期可为先天性或后天获得性,对腹部血管有重大影响。由此导致的门静脉血栓形成、布加综合征和肠系膜静脉血栓形成会产生多种后果,从急腹症到慢性肝肿大,甚至在唯一发现是全血细胞减少的完全无症状患者中也会出现。诸如食管静脉曲张、门静脉性胃病、腹水、严重脾功能亢进、需要肝移植的肝功能衰竭等并发症是众所周知的。侧支静脉循环表现为假胆管癌征及其可能作为胆汁淤积的临床反映等有趣特征也早已为人所知。腹内血管血栓形成这些并发症的管理策略与肝硬化门静脉高压症的管理策略并无不同,但前一种情况的预后无疑更好。在本综述中,我们介绍并讨论了腹部静脉血栓形成、病因及由此产生的临床表现。在命名以及包括抗凝问题和随访策略在内的管理方面都存在有争议的问题。根据当前的知识,我们讨论了文献中的一些争议问题,并介绍了我们对这组患者的经验和建议。